CASE STUDY: making breast-feeding easy

Why does only one in 100 mums follow government advice to feed her baby solely on breast milk for the first six months? Mike Stones meets the woman determined to change that.

'Some women would march up Everest to breastfeed their baby. Others need support, and that’s the role of the Baby Cafe.’

Hyperbole is rare from the lips of Catherine Pardoe, co-founder of the Baby Cafe, a national network of drop-in centres dedicated to promoting breastfeeding. During a two-hour conversation almost all her comments are measured, even restrained – except this. Not even the dubious marketing tactics of formula milk manufacturers sparks a change in her tone.

So, Pardoe’s opening remark underlines the depth of her passion, commitment and dedication – not to bully women into breastfeeding, but to give them the choice. It’s a choice often denied in modern society – denied by peer-group pressure, myths and the omnipresence of persuasive bottle feeding marketing campaigns.

‘Nine out of 10 women who stop breastfeeding in the first six weeks wanted to carry on,’ says 41-year-old Pardoe. For her it’s an exasperating statistic with profound consequences for the physical and psychological health of mothers, their children and the environment. Ultimately, it was a statistic that launched a quest to make breastfeeding more popular. After working as a staff nurse and lactation consultant she found the answer, along with co-founder Julie Williams, with the idea of Baby Cafes,offering support for mums who want to breastfeed.

The first opened in Hayward’s Heath Health Centre, in 2000. Seven years later, there are nearly 100 Baby Cafes from Banff in Scotland to Peacehaven in Sussex, run by volunteers under strict rules set out by the Baby Cafe Charitable Trust. Applications for new cafes are strictly vetted and thoroughly supported with starter packs that contain advice on everything from health and safety to public relations.

We are talking in Horley Baby Cafe, in rooms borrowed from the local infant school and against a rising tide of noise. Gathering in the room next door are mums, mums-to-be, infants and babies. Pushchairs are piling up outside; toddlers are grappling with building blocks and mums are chatting over coffee, tea and rock-cakes.

The aim is friendly peer support for breastfeeding in a non-medical environment. Pardoe and her colleagues want to encourage a method of feeding babies that everyone – mothers, the medical establishment, the Government and even formula milk producers – agrees benefits mothers and babies.

But it’s a tough challenge. Only one in 100 mothers follows Government advice and feeds her baby solely on breast milk for the first six months, according to the latest statistics, the Infant Feeding Survey 2005. Although nearly 80 per cent of mums started breastfeeding, only 21 per cent were still breastfeeding exclusively after six weeks, and more than half had stopped. By six months, three quarters of mothers had stopped breastfeeding completely.

That’s despite overwhelming medical evidence that breastfeeding is better for the mother and her child. According to research published in the Health Education Journal (June 2006), it reduces the incidence of childhood diabetes, obesity, asthma, gastroenteritis and some types of childhood cancers, while boosting cognitive functioning. The United Nations Children’s Fund UNICEF estimates that better breastfeeding practises worldwide could save up to 1.5 million children a year.

The best of the breast

For mothers, breastfeeding facilitates the bonding process with babies and is said to protect against ovarian cancer, breast cancer and weak bone in later life.

Pardoe also points to powerful psychological benefits from breast feeding, which often go unreported.

‘Stopping breastfeeding prematurely can cause a lot of grief that’s seldom acknowledged,’ she says. ‘People underestimate the damage. I’ve spoken to grandmothers in their 70s and their sense of loss at not breastfeeding is still with them.’

So why do so many women choose to replace nature’s free and finest with bought-in, bottle-delivered alternatives? I detect a glimmer of exasperation as Pardoe speaks.

‘For some women, particularly young, single mums on low incomes with poor education, breastfeeding is sometimes far down the agenda,’ she says. It’s so easy for worries about housing benefit or maintenance payments to take priority. Peer-group pressure, family opposition and the slick marketing campaigns of formula manufacturers all conspire to help women choose the bottle rather than the breast to feed their baby.

Many first-time mums who choose to breastfeed report feelings of isolation and embarrassment in a society that seems sometimes openly hostile to the practice. Although it is illegal in Scotland to discriminate against breastfeeding women, no such law exists in Wales and England.

Often the attitude of the new mum’s partner and mother can be critical in influencing her decision to continue breastfeeding or, more likely, to stop.

Hit or myth?

Then there is the multitude of myths that cloud the central truth that breast is best for babies, mother and the environment.

Myths such as that there is little difference between modern infant formula milk and breast milk, which is believed by more than one-third of mothers according to Department of Health research. The reality is that infant formula milk does not contain the antibodies, living cells, enzymes or hormones present in breast milk.

Myths such as that breastfeeding will ruin the shape of women’s breasts and bodies. In fact, breast feeding consumes 500 extra calories a day. Plus, medical advice suggests that it helps the womb return to its normal shape and doesn’t affect long term breast-shape.

Myths such as that some women do not produce enough milk to be able to breastfeed. In reality, breastfeeding is a skill that takes practice. Given accurate information and support, virtually all women can breastfeed.

Baby Cafe aim to provide that service for everyone – not just middle class mums who eat lentils and read The Guardian newspaper. ‘We want to put information about breast feeding back into the community. By taking the topic out of a medicalised, clinical setting we hope to make breastfeeding more accessible to as wide a range of women as possible,’ says Pardoe. ‘Sometimes cafes offer a safety-net for stressed, exhausted mothers who may be struggling to raise children alone on low incomes while perhaps grappling with undiagnosed post-natal depression.’

Baby Cafe venues are critical to their success. You won’t find them in cold, dank, dark village halls where hardy souls huddle together over polystyrene cups of lukewarm, instant coffee. Instead they are located in bright, warm, comfortable community centres and schools. The accent is on pleasant surroundings to help mums relax in an atmosphere of mutual support. There’s always a room for private consultations and a baby changing area. The locations must be within easy reach of a bus route and with places to park in an area where women feel safe.

‘So, shall we go next door and meet the mums?’ suggests Pardoe. There’s no lull in the conversation as we walk into the room – the mums have been warned about my visit. There’s a warm aroma of good coffee, comfortable chairs and wall sheets on breastfeeding. The ground is littered with building blocks as toddlers practice their architectural skills.

New mum Loukia explains how, after a painful nine weeks, she was about to give up breastfeeding when she discovered Horley Baby Cafe, ‘Since coming here, I’ve become much more confident about breastfeeding,’ she tells me.

‘My baby is happier, more settled and more confident. I know exactly what’s in my milk and feeding my baby creates a happy time for us both. When I was pregnant, I was bombarded with information about formula milk products. The Baby Cafe helps mothers resist the appalling commercial pressure to use them.’

The milk of human unkindness

Back in the adjoining room, I ask Pardoe whether she thinks the Government is doing enough to protect new mums against the rampant marketing tactics of formula milk manufacturers.

Her reply is surprisingly pragmatic for one so resolutely committed to promoting breastfeeding. ‘The public sector faces its own constraints and bureaucracy,’ she says. ‘Plus, the Baby Cafe arose from generous support (£15,000) from the Department of Health. Given the nature of the public sector, the Government is probably as supportive as it could be.’

The undue influence of formula milk manufacturers is a threat the Government says it takes seriously. In January, in line with EU legislation, the Department of Health and the Food Standards Agency (FSA) introduced stricter controls on the labelling and advertising of all types of milk formula. The new rules are designed to help parents tell the difference between infant formula, which can be used for the first six months and beyond, and follow-on formula, for use only after the age of six months.

Two days before the legislation was to come into force, the FSA received a legal challenge from the Infant and Dietetic Foods Association, which represents baby milk manufacturers. Its aim was to postpone the introduction of the legislation and to apply for a judicial review to test its legality. The challenge was upheld and product labels won’t change until 2010. A similar challenge mounted in Scotland was dismissed swiftly by the legislature.

Whitehall has always ruled out a total ban on the promotion of formula milk, but it recently promised £150,000 a year for a national breastfeeding helpline, and its own advisers, the Scientific Advisory Committee on Nutrition, warned in February that more should be done to support breastfeeding. Some countries, such as Sweden, do ban the promotion of formula milk and report much higher rates of breastfeeding than the Uk.

Could healthcare professionals do more? Again Pardoe is reluctant to criticise. ‘A lot could do more with management support, but you can’t lay the blame at anyone’s door within the health service.’

Pardoe is less forgiving of the formula milk manufacturers. She believes they are denying healthcare professionals' independent, scientific information about their products. This lack of reliable information makes it hard for them to advise on the proper use of formula milk, and that can lead some women to stop breastfeeding prematurely.

‘At worst, the lack of independent scientific information about formula milk can lead manufacturers to collude with mothers to absolve them of responsibility for breastfeeding their babies,’ Pardoe warns.

Her comments are resigned rather than angry. ‘There’s no point wasting your energy being angry with formula milk manufacturers. They’re commercial companies out to make a profit for their shareholders. They work within the law but don’t always abide by the World Heath Organization code.’ The WHO/UNICEF international code bans all promotion of bottle feeding and sets out requirements for labelling and information on infant feeding.

‘It would be great if every formula milk company were ethical, altruistic and had the best interests of mums and babies at heart, but there’s no money in that. Instead, they spend millions on advertising, phone lines and websites to produce non renewable, unsustainable, ethically suspect and highly branded products.That’s one thing we can learn from them – branding. We should re-brand breastfeeding to make it trendy.’

Outside I hear pushchairs departing. People are saying their goodbyes, but they’ll be back – for the fellowship of like-minded mothers, determined to breastfeed their babies despite the commercial and social pressures ranged against them.

Why breast milk is the green choice

• It’s a natural, renewable resource

• There is no environmental contamination involved in its manufacture, processing, packaging, transportation, preparation, promotion or disposal

• It is produced only in the quantities required

Breastfeeding bonus

‘A woman’s decision to stop breastfeeding is only a choice if she has had the relevant information and viable options have been offered.’

The Baby cafe handbook

‘I breastfed for seven months and hardly ever came across other breastfeeding mums apart from at the Baby Cafe.’ Mum

‘It just feels like the right thing to do. It makes you feel so close to your baby and so special.’ Mum

Helping breast beat bottle

• WHO breastfeeding code should become law

• Make public places more breastfeeding friendly

• More paid leave for parents after birth

• Support legislation making it illegal to discriminate against breastfeeding in England and Wales